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DU PA Glomerular DZs
Duke PA Glomerular disease and other Intrinsic Renal Disease
| Question | Answer |
|---|---|
| the initial manifestation of glomerular disease includes | hematuria, proteinuria, new onset hypertension, edema, malaise |
| less than __mg of protein excreted in the urine per day | 50 |
| nephrotic range proteinuria (>__/day) represents diffuse glomerular injury | 3.5g |
| characterized by the abrupt onset of hematuria with RBC casts and or dysmorphic RBCs, proteinuria (usually non-nephrotic range), and impaired renal function | Acute Nephritis syndrome |
| Acute nephritic syndrome is most commonly caused by | proliferative glomerulonephritis (PSGN) |
| Occurs as a postinfectious complication of nephritogenic strains of group A beta-hemolytic streptococcal infection | proliferative glomerulonephritis (PSGN) |
| is typically seen in children 3-12 although it can occur in adults | proliferative glomerulonephritis (PSGN) |
| complete recovery occurs in 90-95% of all patients with | proliferative glomerulonephritis (PSGN) |
| characterized by glomerular hematuria (RBC casts or dysmorphic RBCs) and renal failure developing over weeks to months associated with diffuse glomerular epithelial cell proliferation in Bowman's space leading to cresent formation evident on renal biopsy | rapidly progressive glomerulonephritis (RPGN) |
| characterized by the presence of proteinuria, hypoalbuminemia, edema, hyperlipiduria, and hyperlipidemia | nephrotic syndrome |
| the finding of proteinuria of 3.5g/24hr/1.73m(3) is sufficient for the designation of | nephrotic syndrome |
| nephrotic syndromes are subdivided into active and ___ | bland |
| bland nephrotic syndrome | pure nephrotic |
| active nephrotic syndrome | mixed nephrotic/nephritic |
| the cut off mean GFR when we start to define chronic kidney disease is ___ ml/min per 1.73m(2) | 60 |
| oliguria is a decrease in urine production to less than ____cc per day | 500 |
| sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness | prerenal cause of ARF |
| direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply | intrarenal cause of ARF |
| sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury | postrenal cause of ARF |
| ____ is a decrease in urine production to less than 500 cc per day | oliguria |
| means nonpassage of urine. But, is practically defined as passage of less than 50 milliliter of urine in a day | anuria |
| intermittant inability to maintain extremity posture against gravity. frequency 1-2 hz. pathognomonic for uremia, hepatic failure, and hypercapnea | asterixis |
| how is volume overload measured | JVP |
| You can either measure JVP, or just say that the patient has | JVD |
| Profound dyspnea, Orthnopnea, Decreased arterial oxygenation, Respiratory failure | Pulmonary edema |
| Chest pain, Friction rub, Tamponade physiology | uremic pericarditis |
| BP of 100/60 and HR 120 lying down, BP of 80/40 and HR 140 sitting up | orthostasis |
| low renal perfusion leads to | renal failure |
| hypotension leads to | low reanl perfusion |
| GFR is directly related to | renal perfusion |
| increased creatinine can be caused by | decreased GFR |
| aldosterone leads to reabsorption of | Na+ and water |
| aldosterone leads to secretion of | K+ |
| aldosterone leads to | increased blood volume |
| Infusion of isotonic saline in hypotensive and volume contracted patient. Treatment of underlying illness. Discontinuation of antihypertensives. Discontinuation of diuretics. Octreotide in patients with cirrhosis | Pre-renal Azotemia Therapy |
| anything that can cause dramatic decrease in blood pressure can lead to | ATN |
| muddy brown (dark densely granulated) casts are a tell tell sign for | acute tubular necrosis (ATN) |
| treatment for acute tubular necrosis | Conservative: medical management of volume overload, acidosis, hyperkalemia, uremia. Or Renal replacement therapy:HemodialysisIntermittant hemodialysis, Continuos veno-venous hemodialysis (CVVHD |
| Dialysate: lacks ___ | urea and creatinine |
| dialysis does not | cure the underlying problem |
| the 4 catagories of intrinsic renal failure | vascular, tubular, glomerular, interstitial |
| Renal infarct, Renal artery stenosis, Renal vein thrombosis | Intrinsic Renal Failure - Vascular |
| ___% of the cardiac output goes to the kidneys | 33 |
| ___L of GFR is produced every 24 hours | 180 |
| systolic hypertension >180mmHg, associated with retinal hemorrhage, acute nephrosclerosis | malignant hypertension |
| treatment for malignant hypertension | Nitroprusside, Fenoldopam, Phentolamine, Methyldopa |
| gradual thickening of the skin, internal organs are affected, hypertension triggers progressive renal failure | scleroderma renal crisis |
| treatment for scleroderma renal crisis | ACE inhibition, 5 year survival 65% |
| Cholesterol emboli cause organ damage, Most common after arterial instrumentation in aorta (cardiac cath), Irreversible, Slow progression of ARF (0.1-0.2 mg/dL/day), Diognosis: ARF and typical skin findings (livedo reticularis) | Arthero-Embolic Disease |
| Nephrotoxic substance is damaging proximal tubular cells. Leak of nitrogenous waste into blood leading to decrease in glomerular filtration. Inability to excrete BUN, Cr, potassium, hydrogen ion. Caused by drugs, contrast, cellular breakdown products | Intrinsic Renal Failure - Tubular Nephrotoxic Insult |
| aminoglycosides, ACEIs, NSAIDs, radiocontrast media | most common tubular selected nephrotoxins |
| normal plt | 150,000 to 400,000/mm3 |
| normal Hct | Male: 40.7-50.3%, Female: 36.1-44.3% |
| is a renal injury associated with a) an abrupt deterioration in renal function, b) inflammation and edema of the renal interstitium | Acute interstitial nephritis (AIN) |
| Diseases or drugs cause immunologic response in renal interstitium causing ___ often associated with a systemic immunologic response (e.g. rash). | Acute interstitial nephritis (AIN) |
| azotemia secondary to the inability of urine to flow freely. Obstruction due to extra-renal or intra-tubular barrier. Extra-renal examples: prostate, kidney stones, retroperitoneal fibrosis, GYN cancers | post-renal failure |
| three broad categories of intrarenal disease | glomerular, tubulo-interstitial, cystic |
| active sediment-indicating active inflammation in the kidney, casts will usually contain byproducts of inflammation | nephritic sediment |
| very large quantities of protein in the urine and a lack of tell tale signs of inflammation | nephrotic sediment |
| a biopsy is like | a controlled stabbing |
| nil disease (lipoid nephrosis) is a disease of the kidney which causes nephrotic syndrome and usually affects children (peak incidence at 2-3 years of age) | minimal change disease |
| Taking lots of NSAIDs can lead to | minimal change disease |
| Group A β-hemolytic Streptococcus after impetigo or pharyngitis, MRSA, S.pneumonia, meningococcal infection. Time to onset 1-3 weeks. Clinical presentation:edema, hypertension, gross hematuria, renal failure | Post-Infectious Glomerulonephritis |
| post-infectious glomerulonephritis-elevated IgA levels in | MRSA infection |
| Subepithelial humps, almost pathognomonic for | Post streptococcal GN |
| Epidemiology: most common glomerulonephritis, uncommon in blacks, more common in Asians and Australians. Secondary: Cirrhosis, Celiac Disease, HIV, CMV. Mechanism: Abnormal IgA deposition in glomerulus | IGA nephropathy |
| most important intervention for keeping kidneys alive in IgA nephropathy | perfect blood pressure control (ACEI/ARBs) |
| Male:female ratio 6:1, 10% develop RPGNHighest frequency in 2nd to 3rd decade, Associated with influenza A, hydrocarbon solvent exposure, HLA DR2 and B7 Antigen, Development of anti-Basement Membrane Ab, aka pulmonary and renal syndrome | Goodpasture Syndrome |
| a rare autoimmune disorder characterized by pulmonary hemorrhage, rapidly progressing glomerulonephritis, and antiglomerular basement membrane (GBM) antibody formation. The syndrome typically strikes young men, is rapidly progressive, and can be fatal. | Goodpasture Syndrome |
| pathologic product of many different diseases. Proteinuria, Focal glomerular scarring and consolidation leading to ESRD. 25% of adult nephropathies.vBlacks > Whites. Men > Women. Part of the kidney is diseased and only a segment of the glomerulus. | Focal Segmental Glomerulosclerosis (FSGS) |
| about 1/3 of patients with FSGS who undergo kidney transplantation will | have a recurrance |
| most common nephrotic syndrome. Usually presents in the 5th-6th decade of life. 1/3 will develop ESRD. | Membranous GN |
| 1/3 of these patients will have spontaneous remission, 1/3 will respond to treatment | Membranous GN |
| Acute commonly associated with toxins and ischemia. Chronic can be associated with: Kidney size small and contracted. Decreased urinary concentrating ability. Hyperchloremic metabolic acidosis. HyperkalemiaReduced GFR. | Tubulointerstitial Diseases |
| Chronic Tubulointerstitial disease is most commonly associated with | obstructive uropathy, and vesicoureteral reflux |
| most common genetic disorder affecting the kidneys | polycystic kidney disease |
| rarely symptomatic, until later in life | cystic kidney disease |
| patients with poycystic kidney disease can also develop | polycystic liver |
| patients with poycystic kidney disease can also develop | cancer |
Created by:
bwyche
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